Nonablative 1927 nm Fractional Resurfacing for the Treatment of Facial Photopigmentation

November 2014 | Volume 13 | Issue 11 | Original Article | 1317 | Copyright © 2014

Jeremy A. Brauer MD,a,d David H. McDaniel MD,b Bradley S. Bloom MD,d Kavitha K. Reddy MD,a
Leonard J. Bernstein MD,a,c and Roy G. Geronemus MDa,d

aLaser & Skin Surgery Center of New York, New York, NY
bMcDaniel Institute of Anti-Aging Research, Viginia Beach, VA
cDepartment of Dermatology, Weill Cornell Medical Center, New York, NY
dRonald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY

Abstract

BACKGROUND: Long-term exposure to sunlight, including ultraviolet A and B, produces signs associated with photoaging and photodamage, including laxity and discoloration of the skin. Initial laser treatment for dyspigmentation included the use of ablative lasers, followed by Q-switched lasers and more recently fractional lasers.
OBJECTIVE: We investigated the safety and efficacy of a fractionated 1927nm non-ablative thulium laser for the treatment of photo-induced pigmentation.
METHODS: Prospective multi-center study of subjects with clinically identifiable photopigmentation. The study protocol was approved by BioMed Institutional Review Board (San Diego, CA). Subjects received two treatments with a non-ablative 1927nm fractionated thulium laser (Fraxel Dual 1550/1927 Laser System, Solta, Hayward CA), energy level of 10mJ, coverage of 40% and 4-6 passes. Subject pain, erythema and edema were recorded immediately after treatment. Two dimensional photography was obtained before each treatment and at one and three month follow up visits. Independent blinded physician assessment was performed evaluating overall improvement in appearance as well as pigment specific improvement.
RESULTS: Forty men and women, ages 30 to 80 years, Fitzpatrick skin types I-IV, with photo-induced facial pigmentation were enrolled and treated, and 39 completed the three month follow up visit. Mean pain sensation for subjects during laser treatments was reported to be 4.3 on a 10-point scale. Mean scores for erythema, edema, and skin roughness throughout all treatments indicated moderate erythema, mild edema and mild skin roughness. Assessment of overall improvement was graded as moderate to very significant in 82% of subjects at one month and in 69% of subjects at three months after the second treatment. Assessment of lentigines and ephelides demonstrated moderate to very significant improvement in approximately 68% of subjects at the one month and in 51% of subjects at three months after the second treatment. Independent blinded physician assessment of randomized photography also demonstrated a durable response at three month follow up visit. Treatment was well tolerated and no serious adverse events related to treatment were observed or reported. Study limitations included a limited number of male subjects, lack of Fitzpatrick skin types V and VI, and decrease in improvement at 3 months post-treatment.
CONCLUSIONS: Two treatments with a 1927nm non-ablative fractionated thulium laser produced moderate to marked improvement in overall appearance and pigmentation with high patient satisfaction. The response to treatment was maintained at one and three months follow up.

J Drugs Dermatol. 2014;13(11):1317-1322.

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INTRODUCTION

Long-term exposure to sunlight, including ultraviolet A and B (UVA and UVB), produces signs associated with photoaging and photodamage, including solar lentigines, also known as sun or age spots, dyschromia, textural irregularity, wrinkling, actinic keratosis, skin cancer, and melasma. Dyschromia can be any discoloration of the skin, and most commonly refers to patches of skin that are darker in color than the normal surrounding skin. Sun-induced solar lentigines and ephelides are common forms of dyschromia seen on photo-exposed areas.

Initial laser treatment of UV induced dyschromia, including solar lentigines, involved the use of ablative CO2 and argon devices.1,2,3 With the theory of selective photothermolysis and development of reliable nanosecond pulse duration, quality switched lasers (QS), including the QS Nd:Yag, QS alexandrite, and QS ruby lasers, have been very well studied and regularly used in the treatment of these epidermal pigmented lesions.4,5,6,7,8 Intense-pulsed light (IPL) devices, plasma skin regeneration devices, and fractional photothermolysis devices also provide nonablative

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